University of California, Irvine, Irvine, CA, USA.
STATinMED Research, Ann Arbor, MI, USA.
Curr Med Res Opin. 2022 Dec;38(12):2131-2140. doi: 10.1080/03007995.2022.2115772. Epub 2022 Aug 30.
To provide an updated comparison of the risk and cost of stroke/systemic embolism (SE) and major bleeding between direct oral anticoagulants (DOAC: apixaban, rivaroxaban, dabigatran) and warfarin among non-valvular atrial fibrillation (NVAF) patients.
Adults (≥65 years) initiating warfarin or DOACs between 1 January 2013 and 31 December 2014 were selected from the Medicare database and propensity scores matched 1:1 to balance baseline characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC warfarin. Two-part models were used to compare the stroke/SE- and major bleeding-related medical costs in each matched cohort.
Of the 264,479 eligible patients, 38,740 apixaban-warfarin pairs, 76,677 rivaroxaban-warfarin pairs, and 20,955 dabigatran-warfarin pairs were matched. Apixaban (Hazard Ratio [HR] = 0.46; 95% Confidence Interval [CI] 0.38-0.56) and rivaroxaban (HR = 0.71; 95% CI 0.63-0.80) were associated with a significantly lower risk of stroke/SE compared to warfarin. Apixaban (HR = 0.57; 95% CI 0.51-0.63) and dabigatran (HR = 0.80; 95% CI 0.70-0.90) were associated with a significantly lower risk of major bleeding; rivaroxaban (HR = 1.14; 95% CI 1.07-1.21) was associated with a significantly higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban and rivaroxaban had significantly lower stroke/SE-related medical costs; and apixaban and dabigatran had significantly lower major bleeding-related medical costs.
This real-world analysis showed DOACs to be associated with a lower risk of stroke/SE and major bleeding, and lower medical costs compared to warfarin. Among them, only apixaban appears to be associated with a significantly lower risk of all three outcomes collectively: stroke/SE, major bleeding, and lower related medical costs compared to warfarin.
提供更新的非瓣膜性心房颤动（NVAF）患者中直接口服抗凝剂（DOAC：阿哌沙班、利伐沙班、达比加群）与华法林之间卒中/全身性栓塞（SE）和主要出血风险与成本的比较。
从医疗保险数据库中选择 2013 年 1 月 1 日至 2014 年 12 月 31 日期间开始使用华法林或 DOAC 的成年人（≥65 岁），并采用倾向评分 1:1 进行匹配，以平衡基线特征。采用 Cox 比例风险模型估计每种 DOAC 与华法林的卒中/SE 和主要出血风险。采用两部分模型比较每个匹配队列中与卒中/SE 和主要出血相关的医疗费用。
在 264479 名合格患者中，匹配了 38740 对阿哌沙班-华法林、76677 对利伐沙班-华法林和 20955 对达比加群-华法林。与华法林相比，阿哌沙班（危险比[HR] = 0.46；95%置信区间[CI] 0.38-0.56）和利伐沙班（HR = 0.71；95% CI 0.63-0.80）与卒中/SE 风险显著降低相关。阿哌沙班（HR = 0.57；95% CI 0.51-0.63）和达比加群（HR = 0.80；95% CI 0.70-0.90）与主要出血风险显著降低相关；与华法林相比，利伐沙班（HR = 1.14；95% CI 1.07-1.21）与主要出血风险显著升高相关。与华法林相比，阿哌沙班和利伐沙班的卒中/SE 相关医疗费用显著降低；阿哌沙班和达比加群的主要出血相关医疗费用显著降低。
这项真实世界分析表明，与华法林相比，DOAC 与卒中/SE 和主要出血风险降低以及医疗成本降低相关。其中，只有阿哌沙班在卒中/SE、主要出血和较低的相关医疗费用这三个结局方面似乎都与华法林相比具有显著更低的风险。
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